Prevention of Bleeding in Patients with Atrial Fibrillation
Approximately 5 to 8% of patients who undergo percutaneous coronary intervention (PCI) have atrial fibrillation.1-3 Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin is superior to oral anticoagulation with a vitamin K antagonist in reducing the risk of thrombosis in patients undergoing placement of a first-generation stent,4 but oral anticoagulation is superior to DAPT in reducing the risk of ischemic stroke in patients with atrial fibrillation.5 The treatment strategy for patients with atrial fibrillation who have received stents must balance the risk of stent thrombosis and ischemic stroke with the risk of bleeding. A common guideline-supported practice is to combine all three drugs in a strategy known as triple therapy6; however, this approach may result in excessive major bleeding, with rates of 2.2% within the first month and 4 to 12% within the first year of treatment.7...